The federal government has decided against procuring a protein-based COVID-19 vaccine for the fall immunization campaign — despite it being the only type that some immunocompromised people say they have been able to tolerate.

While the mRNA vaccines made by Pfizer and Moderna are effective at preventing severe illness, hospitalization and death, some people with autoimmune diseases say the jabs can come with a terrible trade-off.

Vancouver resident Tracy Casavant has received several mRNA vaccines, an experience she describes as akin to “someone sticking a red hot poker up my spine.” She has ankylosing spondylitis, an autoimmune disease that causes inflammation of the spine and hip joints. The shots have not only triggered immense pain for her, she said they’ve decreased her ability to function. After her last mRNA vaccine in October, it took more than half a year for her to recover. “The baseline I returned to was still worse than the baseline before,” she said.

Linda Wilhelm, a New Brunswick resident and the president of the Canadian Arthritis Patient Alliance, told the IJF she experienced increasingly lengthy rheumatoid arthritis flare-ups after each of her six mRNA shots. The last flare-up took “well over a year” to resolve and had a lasting impact. “My elbow’s quite damaged now,” she said.

Wilhelm steered clear of the Pfizer and Moderna offerings the last time she was vaccinated against the SARS-CoV-2 virus, opting instead for the one made by Novavax. She said she had no reaction to it. Casavant opted for a Novavax vaccine in the spring of 2023. She too said she had no reaction.

Unlike Pfizer and Moderna, Novavax doesn’t rely on mRNA technology. Instead, the company produces an old-school type of protein-based vaccine with an adjuvant that boosts the immune response.

Novavax has updated its COVID vaccine this year to target the JN.1 subvariant of the Omicron strain, while the Pfizer and Moderna vaccines target KP.2, a descendant of JN.1. All have been approved by the U.S. Food and Drug Administration and are under review by Health Canada. Last year, Health Canada approved the mRNAs targeting the Omicron subvariant XBB in September and the protein-based vaccine in December.

In May, Canada’s National Advisory Committee on Immunizations (NACI) issued its guidance on the use of COVID-19 vaccines during the fall of 2024, removing its previous preference for the mRNAs, saying that all the updated vaccines “target the same sublineage” and that “evidence continues to support the effectiveness and safety profile” of Novavax.

Not long after NACI released its recommendations, the Canadian Immunocompromised Advocacy Network (CIAN) learned that the government had ordered only the Pfizer and Moderna vaccines. The group wrote to the prime minister and public health and procurement officials in July, advocating for “broader access to diverse COVID-19 vaccine options” and “increased availability and access to protein-based vaccines, such as Novavax.” It was co-signed by several health care providers and researchers, as well as representatives of other advocacy organizations.

The Public Health Agency of Canada (PHAC) responded on Aug. 26 with the news that not only would it not be increasing access to Novavax, it would be eliminating it altogether for the fall immunization campaign.

Dick Zoutman, a retired infectious diseases specialist who chaired the Ontario SARS Scientific Advisory Committee after the first SARS outbreak in Toronto in 2003, finds the government’s decision troubling.

“COVID is still a very serious health problem,” he said, “and Novavax would give everybody an opportunity to be protected.”